Metastatic neuroendocrine hepatic tumors - Resection improves survival
Department of Human Oncology, University of Wisconsin–Madison, Madison, Wisconsin, United States Archives of Surgery
(Impact Factor: 4.93).
11/2006; 141(10):1000-4; discussion 1005. DOI: 10.1001/archsurg.141.10.1000
The optimal treatment for hepatic metastases from neuroendocrine tumors remains controversial because of the often indolent nature of these tumors. We sought to determine the effect of 3 major treatment modalities including medical therapy, hepatic artery embolization, and surgical resection, ablation, or both in patients with liver-only neuroendocrine metastases, with the hypothesis that surgical treatment is associated with improvement in survival.
Tertiary care center.
Patients with metastatic liver-only neuroendocrine tumors were identified from hospital records.
Patients were subdivided into those receiving medical therapy, hepatic artery embolization, or surgical management.
Effect of treatment on survival and palliation of symptoms was analyzed.
From January 1996 through May 2004, 48 patients with liver-only neuroendocrine metastases were identified (median follow-up, 20 months), including 36 carcinoid and 12 islet cell tumors. Seventeen patients were treated conservatively, which consisted of octreotide (n = 7), observation (n = 6), or systemic chemotherapy (n = 4). Hepatic artery embolization was performed in 18 patients. Thirteen patients underwent surgical therapy, including anatomical liver resection (n = 6), ablation (n = 4), or combined resection and ablation (n = 3). No difference was noted in the percentage of liver involved with tumor between the 3 groups. An association of improved survival was noted in patients treated surgically, with a 3-year survival of 83% for patients treated by surgical resection, compared with 31% in patients treated with medical therapy or embolization (P = .01). No difference in palliation of symptoms was noted among the 3 treatment groups (P = .2).
In patients with liver-only neuroendocrine metastases, surgical therapy using resection, ablation, or both is associated with improved survival.
Available from: Alessandro Uzzau
- "In fact, metastases are well recognized as being the major cause of death among neoplastic patients, and the prognosis of patients affected by unresectable liver metastases is very poor. However, although once metastatic malignancies were commonly considered as a terminal neoplastic stage, nowadays, many different therapeutical options have been introduced in order to provide a safe and efficient treatment for these kinds of patients and improve both their quantity and quality of life    . "
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ABSTRACT: Taking into consideration all primary solid tumors, the liver represents the most common site involved in distant metastasization, also due to its important blood reception from the majority of digestive organs. Despite the abundant literature and guidelines about colorectal liver metastases, there is still great debate about the treatment strategy in the case of non-colorectal ones. Therefore, in this chapter, we reviewed the treatment strategy and surgical indications for the most frequent non-colorectal liver metastases. In the case of neuroendocrine hepatic secondaries, the literature suggests that surgery should be always considered for patients with resectable hepatic disease, as this treatment results more likely to offer the best long-term outcome. For what concerns liver metastases from gastric cancer, surgical approach should always be undertaken if indications are appropriate, after a multidisciplinary discussion to plan an adequate multidisciplinary adjuvant treatment, a proper patient selection, and the exclusion of additional secondary tumors or extrahepatic metastases. Taking into consideration liver secondaries from breast cancer and their chemosensitivity, in the absence of brain and lung lesions, it can be considered a space for liver surgery, especially in the case of single lesions or a maximum of two lesions with dimensions within 3 cm. However, as the number of cancer survivors is progressively increasing and, with it, the number of patients affected by non-colorectal liver metastases, further randomized controlled trials are required in order to better define the benefit of hepatic surgery in these kinds of patients.
Available from: Ser Yee Lee
- "They also found large tumor size, high preoperative Chromogranin A and 5-HIAA levels, and high Ki67 index to be risk factors for recurrence . Musunuru et al. showed that compared to either medical therapy alone, systemic chemotherapy, or transarterial embolization, a combination of surgery and RFA resulted in 100% symptom control and improved 3-year survival rate (83% versus 31%) . "
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ABSTRACT: Management of Neuroendocrine liver metastases (NELM) is challenging. The presence of NELM worsens survival outcome and almost 10% of all liver metastases are neuroendocrine in origin. There is no firm consensus on the optimal treatment strategy for NELM. A systematic search of the PubMed database was performed from 1995-2010, to collate the current evidence and formulate a sound management algorithm. There are 22 case series with a total of 793 patients who had undergone surgery for NELM. The overall survival ranges from 46-86% at 5 years, 35-79% at 10 years, and the median survival ranges from 52-123 months. After successful cytoreductive surgery, the mean duration of symptom reduction is between 16-26 months, and the 5-year recurrence/progression rate ranges from 59-76%. Five studies evaluated the efficacy of a combination cytoreductive strategy reporting survival rate of ranging from 83% at 3 years to 50% at 10 years. To date, there is no level 1 evidence comparing surgery versus other liver-directed treatment options for NELM. An aggressive surgical approach, including combination with additional liver-directed procedures is recommended as it leads to long-term survival, significant long-term palliation, and a good quality of life. A multidisciplinary approach should be established as the platform for decision making.
Available from: Joleen Hubbard
- "At least half of NET patients will have more than 50% of their liver replaced at the time metastases are first recognized , but the percentage of involvement of the hepatic parenchyma by tumor does not necessarily affect surgical outcome . The resection of more than three segments of the liver is necessary in the majority of cases , with a goal of debulking 90% or more of the appreciable tumor burden . "
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ABSTRACT: A preponderance of patients with neuroendocrine tumors (NETs) will experience hepatic metastases during the course of their disease. Many diagnoses of NETs are made only after the neoplasms have spread from their primary gastroenteropancreatic sites to the liver. This paper reviews current evidence-based treatments for neuroendocrine hepatic metastases, encompassing surgery, hepatic artery embolization (HAE) and chemoembolization (HACE), radioembolization, hepatic artery infusion (HAI), thermal ablation (radiofrequency, microwave, and cryoablation), alcohol ablation, and liver transplantation as therapeutic modalities. Consideration of a multidisciplinary approach to liver-directed therapy is strongly encouraged to limit morbidity and mortality in this patient population.
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